2002—2017年上海市女性乳腺癌生存分析

吴春晓; 庞怡; 顾凯; 颜佳颖; 王春芳; 向詠梅; 施燕

doi:10.19401/j.cnki.1007-3639.2025.03.005

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2002—2017年上海市女性乳腺癌生存分析

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- 2002—2017年上海市女性乳腺癌生存分析
- Survival analysis of female breast cancer in Shanghai: a population-based study from 2002 to 2017
- 中国癌症杂志 2025年35卷第3期页码：291-297
- 作者机构：
  
  1. 上海市疾病预防控制中心慢性非传染病与伤害防治所肿瘤防治科，上海 200336
  2. 上海市疾病预防控制中心疾病预防控制信息所生命统计科，上海 200336
  3. 上海市疾病预防控制中心慢性非传染病与伤害防治所，上海 200336
- 作者简介：
  
  [ "吴春晓（ORCID: 0000-0002-7362-6368），硕士，主任医师。" ]
  [ "顾凯，主任医师，上海市疾病预防控制中心慢性非传染病与伤害防治所肿瘤防治科主任。上海市抗癌协会常务理事，上海市抗癌协会儿童肿瘤专业委员会副主任委员，上海市优生优育科学协会阴道镜和宫颈病理专业委员会副主任委员，上海市抗癌协会胃肠肿瘤专业委员会常务委员，上海市医学会肿瘤专科分会委员。长期从事肿瘤登记报告和癌症筛查管理工作，承担多项国家和上海市癌症筛查项目实施和评价，在癌症预防领域有着丰富的经验。" ]
- 基金信息：
  
  国家重点研发计划项目(2022YFC3600805);上海市加强公共卫生体系建设三年行动计划(GWVI-8)
- DOI：10.19401/j.cnki.1007-3639.2025.03.005
  中图分类号： R737.9
- 收稿：2025-02-12，
  
  修回：2025-03-20，
  
  纸质出版：2025-03-30
- 稿件说明：
移动端阅览
吴春晓, 庞怡, 顾凯, 等. 2002—2017年上海市女性乳腺癌生存分析[J]. 中国癌症杂志, 2025,35(3):291-297.

Chunxiao WU, Yi PANG, Kai GU, et al. Survival analysis of female breast cancer in Shanghai: a population-based study from 2002 to 2017[J]. China Oncology, 2025, 35(3): 291-297.
吴春晓, 庞怡, 顾凯, 等. 2002—2017年上海市女性乳腺癌生存分析[J]. 中国癌症杂志, 2025,35(3):291-297. DOI： 10.19401/j.cnki.1007-3639.2025.03.005.

Chunxiao WU, Yi PANG, Kai GU, et al. Survival analysis of female breast cancer in Shanghai: a population-based study from 2002 to 2017[J]. China Oncology, 2025, 35(3): 291-297. DOI： 10.19401/j.cnki.1007-3639.2025.03.005.

摘要

背景与目的：

上海市疾病预防控制中心每年更新上海市恶性肿瘤流行统计资料。乳腺癌是女性常见的恶性肿瘤之一，近年来上海市女性乳腺

癌发病率仍在上升，死亡率已呈下降趋势，本研究旨在进一步分析2002—2017年上海市女性乳腺癌诊断病例的生存情况。

方法：

采用上海市疾病预防控制中心建立的人群基础肿瘤登记管理系统和全死因登记系统收集的2002—2017年上海市女性乳腺癌发病、死亡和随访资料，按诊断年份、年龄、病理组织学类型和诊断时期别分层分析，计算数量、构成比和生存率指标。5年观察生存率应用寿命表法计算，应用Elandt-Johnson模型推算0~99岁逐岁的生存概率，再根据Ederer Ⅱ方法计算期望生存率，最终获得5年相对生存率。应用Joinpoint软件计算生存率的年度变化百分比（annual percent change，APC）并分析变化趋势。

结果：

2002—2017年上海市女性乳腺癌诊断病例共73 600例，其中病理学诊断67 681例，占91.96%。截至2022年12月31日，已死亡23 745例（32.26%），因肿瘤死亡19 466例，占所有病例的26.45%；已死亡和随访生存期满5年的完全随访病例共68 332例（92.84%）；失访病例5 268例（7.16%）。纳入观察队列73 538例，占99.92%。逐年观察病例数从2002年的3 330例增长至2017年的6 095例，增幅接近翻倍；5年观察生存率从2002年的78.77%动态变化至2017年的84.55%，呈现缓慢增长趋势，年均增速为0.50%（APC=0.50%，

=8.75，

0.001）；5年相对生存率也从83.46%缓慢增长至89.24%，年均增速为0.47%（APC=0.47%，

=9.80，

0.001）。2002—2017年上海市女性乳腺癌总体5年观察生存率为83.24%（82.96%~83.52%），5年相对生存率为87.58%（87.29%~87.87%），并随着时间变化持续上升，随着年龄的增长而降低，随着诊断时期别的增加而降低。其中，15~64岁各组间的5年相对生存率差异无统计学意义（

0.05）。病例数以期别不详组最多，其次是Ⅱ期组，再是Ⅰ期组。Ⅰ期病例的5年相对生存率达到99.10%（98.78%~99.42%），但仅占25.51%；Ⅳ期病例的5年相对生存率为52.54%（50.98%~54.11%），占6.13%；期别不详组的5年相对生存率为82.04%（81.42%~82.65%），占31.05%。

结论：

上海市女性乳腺癌诊断水平和生存率较高，且仍在不断改善，但组织学类型和期别不详病例所占比例相对较高，Ⅰ期病例所占比例不高，Ⅳ期病例生存率较低。本研究结果可为女性乳腺癌的进一步研究和预防控制提供参考。

Abstract

Background and purpose:

The Shanghai Municipal Center for Disease Control and Prevention provides annual updates on cancer statistics in Shanghai. Breast cancer is one of the common malignant tumors among women. In recent years

the incidence of female breast cancer was increasing

while its trend of mortality showed declining. This study aimed to investigate the survival rates of new female breast cancer cases in Shanghai from 2002 to 2017.

Methods:

Data of new cases and deaths of female breast cancer patients with follow-up information from 2002 to 2017 were obtained from the Population-based Cancer Registry and Vital Statistics System of Shanghai Municipal Center for Disease Contr

ol and Prevention. Numbers

proportions

and survival rates were stratified by year of diagnosis

age

histological type and stage at diagnosis for analysis. The 5-year observed survival rates were calculated based on the life table method. The probabilities of surviving from 0 to 99 years were estimated with the Elandt-Johnson model

and then cumulative expected survival rates were calculated using the Ederer Ⅱ method. Finally

the 5-year relative survival rates were calculated. The annual percent change (APC) of survival rates was estimated by Joinpoint Regression Program.

Results:

A total of 73 600 new female breast cancer cases were diagnosed from 2002 to 2017 in Shanghai. Among them

67 681 cases were morphological verification

accounting for 91.96%. By December 31

2022

23 745 (32.26%) cases had died

and 19 466 (26.45%) cases had died of cancer. A total of 68 332 (92.84%) cases

who were either dead or followed for over 5 years

were considered to have complete follow-up. The remaining 5 268 (7.16%) cases were lost to follow-up. 73 538 (99.92%) cases were included in the observed cohort for survival analysis. The number of observed cases nearly doubled from 3330 in 2002 to 6095 in 2017. The 5-year observed survival rate changed from 78.77% in 2002 to 84.55% in 2017 dynamically

showed a low increasing trend with an average rate of 0.50% per year (APC=0.50%

=8.75

0.001). The 5-year relative survival rate also increased from 83.46% to 89.24% slowly

with an average rate of 0.47% (APC=0.47%

=9.80

0.001). The overall 5-year observation survival rate of female cancer was 83.24% (82.96%-83.52%)

and the 5-year relative survival rate was 87.58% (87.29%-87.87%) in Shanghai from 2002 to 2017. It was increasing over time

decreasing with aging and advanced stage at diagnosis continuously. There was no significant difference in the 5-year relative survival rates between the groups aged 15 to 64 (

05). The group with an unknown stage had the highest number of cases

followed by the stage Ⅱ group

and then the stage Ⅰ group. The 5-year relative survival rate of cases with stage Ⅰ disease reached 99.10% (98.78%-99.42%)

but these cases only accounted for 25.51% of the total. The 5-year relative survival rate of cases with stage Ⅳ disease was 52.54% (50.98%-54.11%)

and these cases accounted for 6.13% of the total. The 5-year relative survival rate of cases with s unknown stage was 82.04% (81.42%-82.65%)

and these cases accounted for 31.05% of the total.

Conclusion:

The diagnostic levels and survival rates of female breast cancer in Shanghai were relatively high and continue to improve. However

the proportions of cases with unknown histological type and unknown stage remain relatively high

and the proportion of stage Ⅰ cases is not very large. The survival rates of stage Ⅳ cases are relatively low. This study provides evidence for further research

prevention and control efforts for female breast cancer.

关键词

Keywords

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